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Management of periprocedural anticoagulant therapy: a novel individualized approach-a transeusophageal echocardiographic study.

Abstract：

:Patients with non-valvular atrial fibrillation who are under chronic oral anticoagulant therapy (OAC) treatment frequently require interruption of OAC treatment. By examining the presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (SEC) with transesophageal echocardiography (TEE) we aimed to develop an individualized strategy. To test the validity of CHA2DS2VASc score based recommendations was our secondary purpose. In this prospective study patients with non-valvular atrial fibrillation on OAC therapy were included. Patients' baseline characteristics, CHA2DS2VASc and HASBLED scores, medications, type of invasive procedures and clinical events were recorded. Each patient underwent to TEE examination prior to the invasive procedure. Bridging anticoagulation was recommended only to patients with LA/LAA thrombus. We included 155 patients and mean CHA2DS2VASc score of the study population was 3.4 ± 1.4. Seventy-one of them had LA/LAA thrombi or SEC on TEE examination and bridging anticoagulation was applied. OAC treatment was not bridged in 8 of 11 patients with prior cerebrovascular accident and 17 of 31 patients with CHA2DS2VASc score of > 4. 57 of 124 patients with CHA2DS2VASc score of ≤ 4 required bridging anticoagulation. There were 14 major bleedings decided according to ISTH bleeding classification. Major bleeding was observed only in patients underwent to high-risk bleeding procedure. In conclusion CHA2DS2VASc score by itself is not enough for decision-making regarding ischemic risk. Furthermore, since major bleedings occurred only in patients underwent to high-risk bleeding surgery, TEE-based individualisation may be a feasible approach particularly for those with high thromboembolic risk undergoing high-bleeding risk procedure.

journal_name

J Thromb Thrombolysis

journal_title

Journal of thrombosis and thrombolysis

authors

Durmaz E,Karadag B,İkitimur B,Ebren C,Tokdil H,Koca D,Ozmen E,Polat F,Ohtaroglu Tokdil K,Raimoglu U,Mutlu D,Atici A,Ongen Z

doi

10.1007/s11239-020-02104-9

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

408-415

issue

eissn

0929-5305

issn

1573-742X

pii

10.1007/s11239-020-02104-9

journal_volume

pub_type

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Management of periprocedural anticoagulant therapy: a novel individualized approach-a transeusophageal echocardiographic study.